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FOR O"FF,�CE USE: 4 ------ ,);` -_ ---- APPLICATION FOR SANITATION PERMIT y ,r = Permit No. ------------------------ --- / (Complete in Triplicate) --_-._-___________________ This Perniif Expires 1 Year From Date Issued Date.Issued` =-� Application is hereby made to the San Joaquin Local. Health District for a permit to construct and install the work herein described. This application is made in compliance—with County O.pr5l mance No. 549 andxisting Rules and Regulations: JOB ADDRESS/LOCATION - - _ .__.C_«_.f _� fAM-1-?/$� _ EJ B Owner's Name _.V"n ------------- - ' f o @ �1 Address --��. -- �_ 'i. .frf �i _ `'� Y *'—� X Ph Cit ,i 'r __ Contractor's Name .� _ License __--- Phone )(-O_ � t ! Installation will serve: Residence l7Apartritient House❑ Commercial`'❑Trailer Court ',❑ { Motel ❑ Other `-`---------- ---�i-_--t----------------•- � Number of living units: _____ Number of bedroo�s '._.�_Garbage Grinder - _..__ Lot _ � � ------------------- 4 t - Water Supply: Public System and,name -------------------I- �' '` " �� Pry / ❑ y�❑ ; T------ i at Character of soil to a depth of 3 feet: Sand' Sift Clay Peat,❑ _Sand -Loam.; _ Y �. Y a Loam Hard-an-E] -Adobe ❑ FiI.I,: ateriaf �=.- (Plot plan, showing size of lot, location of system;in relation o welfuildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septicjtank or seepage pit permitted`1 public wer'is available within 200 feet,)�_/ �j PACKAGE TREATMENT [ ] SEPTIC TANK [e Size _ --y�---_ Liquid Depth Yd----------------- a ` } z Capacity� -40.0_--- TYp ---7?W? Materiale��6 ' No. Compartments:____-___ _.___. . ` i Distance to nearest: Well ; D -_`� ___..Foundation /�________________ Prop. Line_-`.:_:________ LEACHING LINE [! No. of Lines - --------------#_ Length of#each line--- 0_s-------------- Total Length 11�0__-- _ 'D' Box X-1 --- Type Type FilterlMaterial o T * --� t � r'-t-a��---------Dep�h Filer Material l�--------------------•(-----•-••---- Distance to nearest: Well _-: � Foundation �Q Property Line �__ ______________ SEEPAG�'PIT "["] Depth '" Diamete�i .'—'`Number "`"^ = " i --� _ _ Rock`filled Yes- ❑-�-No-❑` Water fiab!'e Depth `----"----1--- =------{-----------Rock'Size 1 s 3 Distance to nearest: Well -----------------------�__-------_w- _Fo_unda''tion -------------------- Prop. Line _--------- -- __ REPAIR/ADDITION(Prev. Sanitation,Permit# _________I_ _________________ "1-- _ Date i 1 --' -----------------•------ 1 Septic Tank (Specify Requirements) _-_T 1f___ ,e j _ 15' j? ---A,:Ci--- i t I i L Disposal Field (Specify Requirements) _ 1 111��? )-m a l __ / -------------------------------- i ---------------------------- ------------------------------------------------------------------------------------ -------------------{-- y i _ - t-- —_ r __ ----------------------- '(Draw existing and required a�ddifion on reverse side'.11 )"--�'-- -_ �—•--��.-� t hereby certify that I have prepared this application and that the work will gel in accordance with San Joaquin i County Ordinances, State Laws, and Rules and Regulations of the, San Joaquin,local Health District. Home owner or licen- sed agents signature certifies the following: I certify that in the performance of the work for which this permit is issued, ljshall not employ any person in such manner i4f j as to become subject to Workman's'Compensation laws of Cafifornia." Signed - ,.J` i Owner i. --- --------- -------------- BY ------------------ # Title(Jf ' ' d �--`------------ t - 1 (If other than owner) i ` ! i FOR LEPARTME NT' USlE ONLY .1 APPLICATION ACCEPTED BYQ- -_' _----- ---- - 1- ----------------------BUILDING PERMIT ISSUED -- DATE -------------•------- .7 --------------------------------- ---------- ------ ------DATEADDITIONAL COMMENTS ---------------- i [ t - -------------------------- -------------------- . ._ e ---------- -------------------- --------------- _ _ __- _ , -- - - --- --- ------- Finallnspection { 4 .x --•---- p w-� �- ` __ 3 ---------- ---- ---------------------------- Final ---- at �: SAN JOAQUIN LOCAL HEALTH DISTRICT } E. H. 9 1-'68 Rev. 5M